Provider Demographics
NPI:1073597050
Name:DAVIDSON, ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 TRENT RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2220
Mailing Address - Country:US
Mailing Address - Phone:252-514-2155
Mailing Address - Fax:252-514-0303
Practice Address - Street 1:3515 TRENT RD
Practice Address - Street 2:SUITE 9
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2220
Practice Address - Country:US
Practice Address - Phone:252-514-2155
Practice Address - Fax:252-514-0303
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16343207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8927222Medicaid
NC27222OtherBCBS PROVIDER NUMBER
NCP00171842OtherRR MEDICARE
NC205764EMedicare ID - Type Unspecified
NC27222OtherBCBS PROVIDER NUMBER